Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 2018015359 | MO |
N | 122300000X | Dentist | DS040417 | PA |
Y | 1223P0106X | Oral and Maxillofacial Pathology | 2018015359 | MO |
NPI | 1083082515 |
---|---|
Provider Name | Dr. Richard J. Vargo |
First Address | Saint Louis, MO 63104-3024 |
Second Address | Saint Louis, MO 63104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2015 |
Last Update Date | 18/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
400078066 | (05) | MO |